Oct 14, 2009

Human rights are the wrong basis for healthcare

The agonising US healthcare debate has taken on a new moral tone. President Barack Obama recently held a conference call with religious leaders in which he called healthcare “a core ethical and moral obligation”. Even Sarah Palin felt obliged to concede: “Each of us knows that we have an obligation to care for the old, the young and the sick.”

This moral turn echoes an international debate about the “right to health”. Yet the global campaign to equalise access to healthcare has had a surprising result: it has made global healthcare more unequal. ...

...So what is the problem? It is impossible for everyone immediately to attain the “highest attainable standard” of health (as the health rights declaration puts it). So which “rights to health” are realised is a political battle. Political reality is that such a “right” is a trump card to get more resources – and it is rarely the poor who play it most effectively.

The biggest victory of the “right to health” movement has been the provision of aid-financed antiretroviral treatment for African Aids patients, who include the upper and middle classes. Aids treatment got funding from, among many others, the Bush and Obama administrations, the Clinton Foundation, the Gates Foundation and the UN Millennium Development Goals campaign. The WHO 2004 report that emphasised the “right to health” did so on behalf of only one specific effort – Aids treatment.

Saving lives in this way is a great cause – except to the extent that it takes resources away from other diseases. Alas, many observers fear that is exactly what it did. ...

...The lesson is that, while we can never be certain, the “right to health” may have cost more lives than it saved. The pragmatic approach – directing public resources to where they have the most health benefits for a given cost – historically achieved far more than the moral approach.

In the US and other rich countries, a “right to health” is a claim on funds that has no natural limit, since any of us could get healthier with more care. We should learn from the international experience that this “right” skews public resources towards the most politically effective advocates, who will seldom be the neediest.

Wealthy person. By spending an additional $10,000 a year on health regimen over the next 20 years we can add 3 months to her life expectancy her life.

Poor person. By spending an additional $1,000 a year on a health regimen over the next 20 years we can add 3 years to her life expectancy ... and to one hundred of her neighbors.

The wealthy person is better positioned to press her "right to healthcare" over against the those with poverty. Resources end up being routed away from those who could most benfit.

Easterly is making the case that this what happened with AIDS drugs in Africa. Upper and middle class people pursued their right to healthcare rather than bearing than footing the cost themselves and freeing up resources for those in need. As long as it is a right, the wealthy can't be denied free access.